SAMPLE TEMPLATE - Amazon S3 · Web viewType of Organisation (Pty Ltd, Public Ltd, Partnership/Sole...
Transcript of SAMPLE TEMPLATE - Amazon S3 · Web viewType of Organisation (Pty Ltd, Public Ltd, Partnership/Sole...
PROCEDURAL FORMPF-7-05-04 SUPPLIER PRELIMINARY QUESTIONNAIRE
1 ORGANISATION PROFILE
Will your organisation comply, if required, with Our Code and our Anti-Corruption policy? Yes No
Is your Company a Supplier Contractor
Registered Name
Postal Address
Post Code
ABN No.
Trading Name
Email Address
Name of Bank
BSB
Account Number
Type of Organisation (Pty Ltd, Public Ltd, Partnership/Sole Trader)
Number of Employees
Please provide contact details within your Organisation
Position Name Telephone Email Address
Manager
Sales/Estimating
Production/Construction
Accounts
Who is your contact for the Company?
Contact Name
Does your organisation have a minimum of 25% indigenous ownership? Yes No
2 INDUSTRY CLASSIFICATION
Select your Organisations primary business
Accommodation & Diners Business Services ConstructionCultural & Recreational Services Education & Training Finance & InsuranceHealth & Community Services Information Tech & Comm MiningManufacturing Plant & Equipment Retail TradeTransport & Storage Wholesale Trade Other (please specify)
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Please detail your Organisation’s Work Type, i.e. if Construction, the Work Type may be concreting, or drilling etc.
3 LEGAL
Has your Organisation been prosecuted by a regulatory body? Yes No
If Yes, please provide further information
Is your Organisation involved in any bankruptcy or reorganisation proceedings? Yes No
If Yes, please provide further information
4 REFERENCES
Provide contact information for your current or previous 3 jobs
Name Referee 1 Referee 2 Referee 3
Client Name
Contact Name
Contact Details
Fax Number
Email Address
Value $
5 INSURANCES
Please complete and supply copies of current certificates of insurances in ALL INSTANCES
Insurance Type Insurer Policy Number Expiry Date Value
Workers Comp
Professional Indemnity
Public Liability
Motor Vehicle
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Other - Marine Cargo Ins
6 REGISTRATIONS AND LICENCES
Provide details of, and expiry dates of all statutory Registrations and Licences held by your Organisation for example: Builders, Classified Plant, Painters, Registrations, Plumbing, Electrical, Gas, Dangerous Goods, Radiation, Explosives, Dewatering, Demolition Licences, etc.
S. No Registration Type Registration Number Expiry Date
1
2
3
4
Provide details of licences
S. No Licence Type Licence Number Expiry Date
1
2
3
4
7 ORGANISATIONAL STABILITY
How long has your Organisation been in business in Australia?
What percent of your Organisations business is repeat work from existing clients?
What is the number of years of Construction industry experience of your Organisation?
Has your Organisation ever been involved in legal proceedings with a Client?
Has any Partner, Principal or other person with an interest in the Organisation ever been associated with any other Organisation or any entity which has failed in the last 5 years to complete a Contract?
8 PERSONNEL QUALIFICATIONS
What is the average number of years of Construction industry experience of your workforce?
What percentage of your management team have recognised technical, tertiary and/or trade
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qualifications?
What percentage of your field personnel have recognised trade certificates?
What percentage of your plant operators hold relevant National tickets to operate mobile plant?
9 PLANT & EQUIPMENT
What percentage of your plant & equipment is more than 5 years old?
Is your plant and equipment regularly serviced and maintained?
Is maintenance history/service records available for your plant and equipment?
What is the condition of your plant and equipment?
When bringing mobile plant on our site will you provide risk assessments and service records?
10 QUALITY
Is your Organisation accredited to ISO 9001 or equivalent standard? If you answer NO, go to Part B.
If yes provide details
Accreditation Standard
Accreditation Body
Certificate Number
Certificate Expiry Date
Date of Last Audit
No. of Non-conformances in last audit
Part B: If you Organisation is not accredited to ISO 9001 or equivalent standard, then answer following question
How many of the following checklists and controls are documented are in use in your Organisation?
Tender & Contract review
Resource Control
In-process Inspection
Non-Conformance Control
Purchasing Control
Incoming Inspection
Records Control
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Calibration & Maintenance
Will you conform to our Quality Management System and site specific Quality Management Plan?
Yes No
11 OCCUPATIONAL SAFETY & HEALTH (OSH)
Is your Organisation accredited to AS 4801 or equivalent standard? If you answer NO, go to Part B.
If yes provide details
Accreditation Standard
Accreditation Body
Certificate Number
Certificate Expiry Date
Date of Last Audit
No. of Non-conformances in last audit
Part B: If your Organisation is not accredited to AS 4801 or equivalent standard, then answer following questions
Does your Organisation have a documented OSH Policy?
Are employees involved in developing Job Hazard Analysis/SWMS?
Does your Organisation have a documented incident/accident investigation procedure?
Are Supervisors/Senior Management involved in incident/accident investigation?
Are Material Safety Data Sheets (MSDS) available to all employees for hazardous substances?
Does your Organisation have an Alcohol & Drugs Policy and procedures in place?
Are records maintained for all training and induction programs undertaken for your employees?
Does your Organisation conduct regular workplace inspections?
Does your Organisation have formal processes in place for handling workplace grievances
Has your Organisation had any fatalities or permanent disabilities accidents in the past 3 years?
Provide safety statistics for the last 3 years
S. No Year No. of Lost Time Accidents No. of Medically Treated Injuries
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1
2
3
Will you conform to our OSH Management System and site specific OSH Management Plan? Yes No
12 ENVIRONMENT
Is your organisation accredited to AS/NZS ISO 14001 or equivalent standard?
If yes provide details
Accreditation Standard
Accreditation Body
Certificate Number
Certificate Expiry Date
Date of Last Audit
No. of Non-conformances in last audit
If no, answer the following questions
Do you have procedures in place to ensure that project planning identifies environmental risks?
Do you establish environmental management plans that address identified project risks?
Has your Organisation been issued with any infringement notice by Environmental Protection Agency in last 2 years?
Will you conform to our Environmental Management System and site specific Environment Management Plan? Yes No
13 INDUSTRIAL RELATIONS
Does your Organisation have a documented Industrial Relations Policy?
Did your Organisation have any industrial disputes in the past 3 years?
What type of Industrial Instrument does your Organisation have in place?
If your Organisation is associated with any Unions, then provide name of the Union
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DECLARATION
On behalf of our Organisation, I hereby certify that the information provided in this questionnaire is an accurate reflection of our Organisation and we will provide appropriate documented evidence if requested. I also confirm access will be permitted to our Organisation premises for audit if requested.
Name of Organisation
Name of Authorised Signatory
Position
Date
Signature
For office use only
Name of Assessor Date
Signature Rating Approved Review
Comments
Commercial Manager/System Manager approval:
Name Date
Signature
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